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Breast cancer is a malignant tumor, or cancer, that begins in the cells of the breast. Breast cancer can affect both men and women, but it is about 100 times more common in women
The first sign of breast cancer is often a lump in your breast or abnormal mammogram. Breast cancer staged range from and early, curable disease to metastatic breast cancer—which means that the cancer has spread beyond the breast into other parts of the body.
There are two main types of breast cancer:
Ductal carcinoma begins in the breast ducts, behind the nipples. Ductal carcinoma affects 7 to 8 out of every 10 women with breast cancer and 9 out of 10 men with breast cancer.
Lobular carcinoma starts in the lobules, where the mammary glands are found. It affects 1 out of 10 women with breast cancer and 1 out of 50 men with breast cancer.
The remaining 1 in 5 women and 2 in 25 men with breast cancer may suffer from a combination of both types, or from a less common type, such as inflammatory breast cancer or Paget’s disease of the nipple.
No one knows for sure what causes breast cancer. Breast cancer starts when some cells in the breast begin to divide more rapidly than they should, and grow into a tumor. This extremely rapid growth is called metastasis. Doctors don’t know why some cells metastasize and others don’t. But there are risk factors that can tell you how likely you are to have breast cancer.
The biggest risk factor for breast cancer is being female. In the United States, breast cancer affects 1 out of 8 women in their lifetimes, but only 1 in 1000 men. Breast cancer is the second most common type of cancer in women. Other risk factors include:
Your age. Two-thirds of all breast cancers occur in women older than 55.
Your genes. 1 out of every 10 to 200 people with breast cancer have a gene passed down from their family that puts them at increased risk. If breast cancer runs in your family, you can be tested for these genes.
Your cancer history. If you’ve had breast cancer before, you’re more likely to have it again.
Your reproductive history. Breast cancer is more likely if you had your first child after age 35, and even more likely if you’ve never been pregnant. It’s also more likely if you started puberty early, started menopause late, or if you’re taking hormone therapy for menopause.
Radiation exposure. Radiation treatments to your chest when you’re young can increase your future risk.
Other conditions affecting your breasts, such as cysts, hyperplasia, or simply dense breast tissue.
Your weight. Breast cancer is more likely if you’re obese.
Your doctor will likely ask you questions, such as when you noticed your lump or other symptoms. Your doctor will also check your breasts for lumps or other problems. Having your doctor touch your breasts may make you nervous or uncomfortable, but rest assured it is a part of routine health care.
Your doctor will also perform other tests, such as a mammogram, an ultrasound, or magnetic resonance imaging (MRI) of the breast. If cancer is suspected, your doctor will remove a biopsy sample to send to the lab for testing.
Doctors recommend that you be aware of your breasts and watch for any changes, but since In its early stages, breast cancer usually has no symptoms, it’s important to know what to be on the lookout for in case something develops.As a general rule of thumb, be on the lookout for an area that is distinctly different from any other area on either breast in feel, texture, bumpiness, or other change from your norm. Causes for concern include:
A lump or thickening in your breast that persists after your menstrual cycle. Often—this is one of the first symptoms or signs of breast cancer. Lumps associated with breast cancer are usually painless, though some may cause a prickly or tingly sensation. While examining your breasts to understand how they change throughout the month is useful, lumps are usually visible on a mammogram long before they can be seen or felt.
Swelling or lump in the armpit.
Pain or tenderness in the breast. Although lumps are usually painless, chronic pain or tenderness can be a sign of breast cancer.
A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
Changes to the size or shape of your breast. Any change in the size, contour, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
A change in your nipple, such as peeling, flaking, turning inward, a dimpling, itching, a burning sensation, A scaly rash of the nipple is symptomatic of Paget’s disease, a rarer form of breast cancer, and may indicate possible underlying breast cancer.
Unusual nipple discharge that may be clear, bloody, or another color. It’s usually caused by benign conditions but could be due to cancer in some cases.
Dimpling or a round, marble-like area under the skin of the breast.
Early breast cancer usually does not cause physical pain, and symptoms may not initially be noticeable. As the cancer grows, it can cause changes that include:
If you notice any of the above symptoms, contact your doctor immediately for an examination. These symptoms are often associated with breast cancer that has progressed from its earliest stages. Mammography can often detect a breast cancer before it is large enough to produce any of these symptoms. For this reason, regular mammograms are recommended, making it more likely that breast cancer will be detected at its earliest and most curable stages.
The outlook for people with breast cancer is better than ever before, thanks to early detection and improvements in understanding and treatment. But breast cancer can still be lethal if it’s not caught early. Out of all cancers, breast cancer is the second most common killer of women, after lung cancer.
If your cancer is caught by stage 1—that is, if the tumor is peanut-sized or smaller and the cancer has not spread far, then five-year survival is 100%. Survival remains as high as 93% at stage 2, when the tumor is small or very localized, and 72% at stage 3. But 5-year survival drops sharply to 22% at stage 4—that is, if the cancer spreads to the lungs, liver, bones, or brain.
Generally, the goal in breast cancer treatment is to eradicate the cancer, but the disease and its treatments can impact your life. For instance, radiation and chemotherapy may cause nausea, fatigue, or other problems, and surgical treatments can affect your body image.It helps a great deal to talk openly with family, friends, and other breast cancer survivors.There are also medicines available to help with nausea and fatigue, and you can have reconstructive surgery after a mastectomy to help you feel better about your body.
After breast cancer treatment, you should follow up with checkups every 3 to 6 months to make sure the cancer has not returned.
Breast cancer screening saves lives—possibly thousands of lives each year—by helping women get treatment early, when the disease is least dangerous. The earlier breast cancer is detected, the better the prognosis in most cases. The best approach to screening for you depends on personal risk factors such as your age and your family history of breast cancer. For most women, the American Cancer Society recommends:
The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.
If you are at high risk for breast cancer, an MRI may also be recommended every year. Talk to your doctor about your risk factors and the best approach for you. If you have a family history of breast cancer, genetic testing can tell you if you have genes that increase your risk.
This is a quick overview of the diagnostic tests used to detect breast cancer:
Breast Self Exam. Self exams are a proactive way to understand your breasts so that you can notice when something changes—and are done at the same time every month. Most lumps are not cancerous, but if you feel one, it’s a good idea to go see your doctor as soon as possible.
Clinical Breast Exam. A clinical breast exam is done by your doctor or other health care professional, and is a regular part of a check up.
Mammogram. A mammogram is a special type of x-ray that looks for changes in breast tissue and abnormal growths. It is the most important tool in detecting breast cancer, though it is not perfect. Most abnormal mammograms are not breast cancer—though an abnormal result does warrant further testing. There has been some controversy about the rate of false positives on mammograms, and the sometimes invasive testing that results to rule out breast cancer.
Breast Ultrasound or Sonogram. Healthcare professionals may use ultrasound images to check whether a breast lump is a solid mass (which may indicate cancer or another condition, like fibroids) or cyst—a fluid-filled sac that is not cancerous.
MRI of breast. An MRI (magnetic resonance imaging) is another diagnostic tool used to detect breast cancer.
Breast Biopsy. During a biopsy, cells are removed from a suspicious lump or mass to ascertain whether they are cancerous. Biopsies are often done after a person has received an abnormal mammogram result.
Needle Biopsy. This is a minimally invasive breast biopsy that uses a needle and not surgery to obtain cell samples for testing.
Sentinel Node Biopsy. With this type of biopsy, physicians check lymph nodes in your underarm to see if cancer has spread into the lymphatic system—a sign of metastasis.
Ductal Lavage. This test checks cells from the milk ducts for precancerous cells.
Although certain genetic factors may not be preventable, there are other precautions you can take to decrease your risk of developing Breast Cancer. If you have a strong family history of breast cancer, Talk to your doctor about whether you should be tested for the breast and Ovarian Cancer gene mutation (BRCA1 and BRCA2). Women who carry this gene are at very high risk for developing breast and ovarian cancers and should be followed closely.
General precautions you can take to reduce your risk of developing breast cancer include:
Talk to Your Doctor About Screenings
Talk to your doctor about the best screening schedule for you. Breast cancer screenings include:
If you have a very strong family history of breast cancer and also have the breast and ovarian cancer gene mutation (BRCA1, BRCA2), you may want to talk to your doctor about the possibility of having a mastectomy before cancer deveops.
Limit Exposure to Estrogen When Possible
High levels of estrogen have been linked to the development of breast cancer. For older women, the greatest exposure to estrogen is via postmenopausal hormone replacement. Therefore, you should have a frank conversation with your doctor as to the risks and benefits of estrogen replacement relative to breast cancer.
Other lifestyle factors may also increase your exposure to estrogen. If possible, try to limit these factors:
Estrogen-Blocking Drugs
There are two FDA-approved medicines to prevent invasive breast cancer in high-risk, postmenopausal women. tamoxifen and raloxifene work by blocking estrogen from binding to “estrogen-sensitive” cells, which prevents the cells from growing and dividing. These medicines do however increase your chances of having blood clots and Stroke.
Maintain a Healthy Weight
Being overweight-particularly after menopause-may increase your chance of developing breast cancer. This is due to the fact that after menopause, most of the estrogen in a woman’s body comes from her fat tissue. The more fat on the body, the higher the degree of estrogen.
Limit Alcohol Consumption
Studies have shown that women who drink 2-4 alcoholic drinks daily have a 40% greater risk of developing breast cancer than nondrinkers. This may be due to the fact that alcohol may alter the way a woman’s body metabolizes estrogen and may cause blood estrogen levels to rise, increasing the risk of breast cancer onset.
Do Not Smoke
Tobacco Use Disorder greatly increases your risk of several cancers, including breast cancer.
Exercise
Exercise helps maintain weight and modulates high levels of estrogen. It is also believed that low to moderate levels of exercise may enhance the immune system, which ultimately may slow the growth rate or kill cancer cells. Overall, exercise has many benefits and is recommended for overall health and reducing the risk of breast cancer.
With advancements in research and treatment technologies, the options for breast cancer treatment are as varied as ever. Choosing the right treatment plan involves a careful consideration of the following:
Because each case of breast cancer is unique, treatment plans can vary greatly from patient to patient. Patients should carefully consider the risks and benefits of each treatment method before choosing a plan. Breast cancer can be treated either locally or systemically.
Local therapy involves the targeted treatment of a specific cancerous site, such as breast tumors or cancerous lymph nodes. Types of local therapy include:
Systemic (adjuvant) therapy is aimed at the entire body. This type of treatment is useful in eliminating cancer cells that have spread to other areas of the body from the site of the initial tumor. Systemic therapy is also called adjuvant therapy, because it is often used in combination with local therapy. Types of systemic therapy include:
The stage of the breast cancer is one of the most important factors to take into consideration when choosing the proper treatment plan. Treatment for breast cancer is as follows
STAGE 0 (Ductal Carcinoma in Situ, DCIS)
In ductal carcinoma in situ (DCIS), the presence of abnormal cells is limited to the milk ducts and has not yet spread to other areas of the body. This is the earliest and most commonly diagnosed stage of non-invasive breast cancer. Treatment for DCIS typically includes:
STAGE I & II (Early Breast Cancer)
Stage I breast cancer is characterized by the presence of tumors no larger than 2 centimeters in diameter. In stage IIA breast cancer, tumors are no larger than 2 centimeters in diameter but cancerous growth has been detected in the lymph nodes. Tumors larger than 2 cm but smaller than 5 cm with no evidence of cancerous growth in the lymph nodes are characterized as stage IIB. Treatment for early breast cancer may include:
Stage III (Advanced Breast Cancer)
In stage IIIA breast cancer, breast tumors are larger than 5 centimeters in diameter and cancerous growth has been detected in the lymph nodes. Tumors in this stage have not reached the breast skin or chest wall. In stage IIIB breast cancer, tumors have spread to involve the breast skin and/or chest wall. In stage IIIC breast cancer, the cancer has spread deep into the lymph nodes and throughout the breast.
Because stage III breast cancers are more severe than DCIS or stages I & II, the treatment is often more aggressive. Treatment for stage III breast cancers includes:
Stage IV (Metastatic Breast Cancer)
Stage IV breast cancers have spread beyond the local area of the breast to different parts of the body such as the bones, liver, lungs, or brain. Cancerous sites in a stage IV breast cancer patient that are not in the local area of the breast are known as metasteses.
Since most cases of stage IV breast cases are widespread, surgical options are less likely to be considered given that they may not eliminate the majority of the cancer cells and may put further stress on a patient. Treatment for stage IV cancers is mainly focused on the systemic slow of cancer growth. These include:
Since the task of completely eliminating or curing stage IV breast cancer can be a daunting one, many patients and doctors choose a palliative approach to treatment. In palliative treatment, doctors and patients focus on physical and emotional comfort during treatment rather than aggressive elimination of the disease. This can help a patient relieve stress, anxiety, and pain while they live with their disease.
Palliative care for stage IV breast cancer may include:
For more information on palliative care, visit the thirdAGE palliative care condition center.
Many patients with breast cancer will need surgery either to remove a cancerous tumor from the breast (breast-conserving surgery) or to remove the entire breast (mastectomy).
Breast-Conserving Surgery. In breast-conserving surgery, a cancerous tumor or small portion of the breast is removed while preserving the rest of the breast tissue. Breast-conserving surgery can also be called a lumpectomy, partial mastectomy, or quadrantectomy. Because these procedures do not involve the full removal of the breast, radiation treatment and/or chemotherapy is often given after the surgery to ensure the death of as many cancerous cells as possible. This mode of treatment works best for those with stage I or II cancer, when it is not yet widespread. If the surgeon is unable to remove all of the cancerous tissue with a lumpectomy/partial mastectomy, he or she may recommend a full mastectomy for the patient.
Depending on the size and location of the tumor, there may still be significant deformation of the breast. Reconstructive surgical options are available to help restore the breast to its original form.
Mastectomy. In a mastectomy, the entire breast (and possibly surrounding tissues) is removed. There are several different types of mastectomies:
Reconstructive Surgery
If surgery has caused significant changes to the appearance of the breast, a woman may opt for reconstructive surgery to help restore the breast to a more normal appearance. Reconstructive surgeries can either be immediate (done in the same procedure as the mastectomy) or delayed (done during a later surgery). To determine which reconstructive and surgical options are best for you, consult with your doctor.
Radiation therapy bombards the site of the cancer with high energy particles that kill the cancerous cells. There are two major types of radiation therapy:
Chemotherapy is a form of cancer treatment in which drugs are administered orally (by mouth) or intravenously (by injection) in order to kill cancer cells throughout the body. Because of its harsh side effects, chemo is given in cycles with a recovery period in between each round. Chemotherapy can be given before surgery (neoadjuvant chemotherapy), after surgery (adjuvant chemotherapy), or in cases where breast cancer has spread to many other parts of the body.
According to the American Cancer Society, the following are among the most commonly prescribed chemotherapy drugs:
Estrogen can promote the growth of certain breast cancers if the cells have receptors for the either the estrogen or progesterone hormones. Cancers that do have estrogen/progesterone receptors (known as ER-positive cancers) may respond positively to drugs that block the reception of this hormone.
Drugs that help block the reception of these hormones include:
There are also drugs that can be given in conjunction with hormone-blocking drugs in order to make hormone therapy more effective. These include:
Targeted therapies work on specific genetic mutations that have been shown to influence the development of breast cancer. An example of a targeted therapy would be the use of drugs that target the HER2/neu protein, which promotes growth within cancerous cells. HER2/neu targeting drugs include trastuzumab, pertuzumab, ado-trastuzumab emtansine, and lapatinib.
Because of their specific nature, targeted therapies are only suitable for certain cases of breast cancer. Ask your doctor about whether or not there is a suitable targeted therapy for you.
Treatments for breast cancer may cause considerable pain in some patients. There are many different ways to deal with breast cancer treatment-related pain, including:
Remission is the disappearance of the signs and symptoms of cancer. Remission may last anywhere from several weeks to several years, or in the best cases, a lifetime. Often, only some cancer symptoms disappear. This is known as a partial remission. Even though there is a chance cancer may never come back one in remission, it is said to be in remission rather than “cured” because doctors cannot guarantee that it will not recur at a later point. Whether or not you experience remission depends on how your body responds to treatment. In addition to the breast cancer treatments that help a patient achieve remission, there are several things your doctor may recommend to help prevent recurrence:
Recurrence is when cancer signs and symptoms reappear after a period of remission. About 20% of breast cancer patients will experience a recurrence within 10 years of initial treatment. The likelihood of recurrence depends on the type of cancer and the body’s response to treatment. The risk of recurrence increases with higher stages of breast cancer. According to the American Cancer Society, a recent study found that the five year recurrence rate for stage I breast cancer is 7% while the rate for stage II is 11% and 13% for stage III. In that same study, the overall recurrence rates for patients who underwent adjuvant therapy were 11% at 5 years after treatment and 20% at 10 years. Treatment for recurring cancers will most likely differ than the initial treatment, given the changes that occur in the body after the first round of treatment.
Breast cancer research is ongoing, and many new drugs and treatment technologies are being developed each year. Before a treatment is FDA approved, it must undergo a series of supervised and controlled tests known as clinical trials. Often, researchers draw on the public for eligible participants in the trials. New treatment methods offer an exciting promise for recovery, but they can also have potentially lethal side effects, especially while still in the clinical trial phase. Speak to your doctor before entering into any clinical trial for breast cancer treatment.
For more information on how to find clinical trials, visit www.BreastCancerTrials.org
There are many complimentary techniques that can help manage treatment side effects, reduce overall pain, and help to increase general wellness throughout breast cancer treatment. These include:
Clinical research on the effectiveness of herbal therapies is limited as it is still ongoing. However, many of these herbs have been used in other medicine forms (such as traditional Chinese medicine and ayurvedic medicine) as anti-inflammatory medicines for centuries.
Mind/body techniques, which help to strengthen the mind and body connection in order to reduce anxiety, stress, and improve overall health. These include:
Massage. Massage has been proven to reduce anxiety, pain, and fatigue as well as increase immune function in cancer patients. According to the Pacific College of Oriental Medicine, a 2003 study of 230 cancer patients found that patients who received one 45-minute massage each week for a month felt less pain and took eight fewer doses of pain medication than those who did not receive massages. Massage therapy has also been shown to increase the body’s NK cell level (which are crucial in fighting off cancerous growth) as well as inhibit inflammatory stress hormones such as cortisol. There are many different types of massage that may be beneficial for breast cancer patients. To find a licensed therapeutic masseuse, visit The American Massage Therapy Association.
Chiropractic therapy. Chiropractic therapy focuses on the alignment of the body’s skeletal system in order to promote overall wellness and reduce pain.
Prayer/spiritual therapy. According to the National Cancer Institute, a study of 418 cancer patients found that a higher level of meaning and peace led to a decline in depression and psychological distress. The effects of prayer as a successful complementary treatment is still a topic of debate. While some believe that the power of others praying can produce extraordinary results, a 2006 study published by the American Heart Journal found a slight negative correlation between prayer and recovery. Patients that knew they were receiving prayer experienced a slightly higher rate of complication than those that did not know they were receiving prayer.
Support Groups. Local or online support groups can significantly bolster a patient’s confidence and feeling of security. Studies have long shown that support groups help to decreased stress, anxiety depression, and treatment complications. To find a support group in your area, visit your local hospital or The American Cancer Society.
In addition to medical and surgical treatment it’s important to take care of yourself. This may include:
You can also take better care of yourself with:
Your medical team may consist of several healthcare professionals, such as a medical oncologist, a surgical oncologist, and/or a radiation oncologist. You should seek out a physician who is skilled and knowledgeable, with whom you feel comfortable asking questions and getting the answers you need.
The National Cancer Institute offers a Web site where you can find a cancer center near you.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with breast cancer. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
Specific Questions to Ask Your doctor
About Breast Cancer
About Your Risk of Developing Breast Cancer
About Treatment Options
If you have been diagnosed with breast cancer, you should first try to get at least one other opinion from another doctor. If both you and your doctor agree with the diagnosis, you may want to get specific information about the surgery, chemotherapy, hormonal therapy, and the radiation therapy. No one doctor will likely answer all of your questions about all of these therapies, but he should be able to give you some general pointers. Additionally, you should get very specific information from the individual specialist.
Surgery
Chemotherapy
Radiation
About Lifestyle Changes
About Outlook
Other useful resources to help you learn about breast cancer can be found at:
American Cancer Society
BreastCancer.org
The National Breast Cancer Foundation
The National Cancer Institute
Behavior Change-Up for a Slimmer You
Extreme Exercise and Heart Health
Change Begins with Letting Go
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